Biopsychosocial Influence on Shoulder Pain

生物心理社会对肩痛的影响

• 批准号: 8886057
• 负责人: STEVEN Z GEORGE
• 金额: $ 63.12万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8886057
• 关键词: Address; Adrenergic Agents; Adrenergic beta-Antagonists; Catechol O-Methyltransferase; Catecholamines; Characteristics; Chronic; Clinical; Clinical Trials; Cognitive; Complex; Data; Development; Enzymes; Etiology; Exercise; Fright; Funding; Genetic; Genetic Polymorphism; Genotype; Goals; Haplotypes; Heating; Individual; Inflammatory; Injury; Institute of Medicine (U.S.); Interdisciplinary Study; Intervention; Intervention Studies; Link; Measures; Medical; Methyltransferase Gene; Modeling; Molecular; Musculoskeletal Pain; Opioid; Outcome; Pain; Pain intensity; Pathway interactions; Patients; Perception; Pharmacologic Substance; Phase; Pilot Projects; Placebos; Population; Postoperative Period; Pre-Clinical Model; Propranolol; Psychological Factors; Randomized; Regulation; Research; Resources; Risk; Risk Factors; Sampling; Scientific Advances and Accomplishments; Shoulder; Shoulder Pain; Societies; Standardization; Subgroup; Translating; United States; Upper Extremity; adrenergic; base; biopsychosocial; chronic shoulder pain; cohort; cytokine; design; disability; economic impact; enzyme activity; experience; genetic variant; group intervention; health care delivery; high risk; individualized medicine; pain inhibition; personalized intervention; personalized medicine; pre-clinical; prevent; psychologic; public health relevance; response; standard of care; therapy design

 DESCRIPTION (provided by applicant): Treatment tailored to specific patient characteristics (i.e. personalized medicine) will have a significant positive impact on the delivery of healthcare. Personalized medicine for musculoskeletal pain conditions is a high priority because these conditions are a heavy burden to society due their economic impact and suffering they cause. Therefore, the ultimate goal of this line of research is to develop personalized interventions for musculoskeletal pain that ameliorate musculoskeletal pain and lessen their burden on society. We study shoulder pain because it is a common musculoskeletal pain condition and in the initial funding period we identified combinations of genetic and psychological risk factors indicative of chronic shoulder pain. In particular, a combination of COMT genetic variants and pain catastrophizing formed a high risk subgroup predictive of heightened shoulder pain responses in a pre-clinical exercise-induced injury cohort and poor 12 month outcomes in a clinical post-operative shoulder pain cohort. This promising and robust finding provided the impetus to transition this line of research to an intervention phase. The renewal application will provide resources for this multidisciplinary research team to determine mechanisms and efficacy of personalized pharmaceutical and psychological pain interventions designed to target genetic and psychological factors that comprise the high risk subgroup. The pharmaceutical intervention will be propranolol as it counters the effects of decreased COMT enzyme. The psychological intervention will be cognitive restructuring that lessen the impact of pain catastrophizing. Our primary hypothesis is that subjects receiving the combined personalized pharmaceutical and personalized psychological intervention will have decreased shoulder pain duration, peak pain intensity, and peak upper-extremity disability following exercise-induced shoulder injury, when compared to the combined placebo condition. In addition, we will investigate psychological, molecular, and pain sensitivity regulation as mechanisms of pain relief. Successful completion of the proposed study will have a strong impact on the field as it has the potential to alter standard of care by discovering effective personalized pain treatments for individuals that, without the treatments, would go on to develop chronic shoulder pain. Completion of this study will also provide critical foundational data for designing a subsequent clinical trial in a post-operative shoulder pain cohort.

 描述（由适用提供）：针对特定患者特征（即个性化医学）量身定制的治疗将对医疗保健的提供产生重大积极影响。 针对肌肉骨骼疼痛状况的个性化医学是当务之急，因为由于经济影响并遭受痛苦，这些条件对社会造成了沉重的烧伤。因此，这一研究的最终目标是为肌肉骨骼疼痛开发个性化干预措施，以减轻肌肉骨骼疼痛并减轻对社会的燃烧。我们研究肩痛，因为这是一种常见的肌肉骨骼疼痛状况，在最初的资金期间，我们确定了遗传和心理危险因素的组合，表明慢性肩部疼痛。特别是，在临床后运动诱发的损伤队列中，COMT遗传变异和疼痛灾难性的灾难性造成了高风险的亚组，可预测肩痛的增加，而在临床后的术后肩部疼痛队列中，COMT遗传变异和疼痛的结合。这一承诺和强大的发现为将此研究线转换为续签应用提供了动力，将为该多学科研究团队提供资源，以确定旨在针对构成高风险子组的遗传和心理因素的个性化药物和心理疼痛干预措施的机制和有效性。药物干预将是普萘洛尔，因为它反驳了降低COMT酶的影响。心理干预将是认知餐厅，此外，我们还将研究心理，分子和疼痛敏感性调节，作为缓解疼痛的机制。成功完成拟议的研究将对该领域产生强大的影响，因为它有可能通过发现有效的个性化疼痛治疗的人来改变护理标准，而那些没有治疗的人会继续发展慢性肩部疼痛。这项研究的完成还将提供关键的基础数据，用于在术后肩痛队列中设计随后的临床试验。